Study shows new antipsychotic drug prevents brain loss in schizophrenia

A new brain imaging study of recently diagnosed schizophrenia patients has found, for the first time, that the loss of gray matter typically experienced by patients can be prevented by one of the new atypical antipsychotic drugs, olanzapine, but not by haloperidol, an older, conventional drug. The study, published in today’s Archives of General Psychiatry, also confirmed previous studies that show patients who experience less brain loss do better clinically.

“This is a really big breakthrough,” says the study’s leader, Jeffrey Lieberman, M.D., director of the New York State Psychiatric Institute and chairman of psychiatry at Columbia University Medical Center. “The drugs we have for schizophrenia can’t cure people who’ve been sick for years, but this study shows that the newer atypical drugs, if started early, can prevent the illness from progressing. If our findings are confirmed, one could argue that we should treat new patients with atypical drugs like olanzapine rather than older conventional medications such as haloperidol and chlorpromazine.”

Gray matter contains the bulk of the brains cell’s and the billions of connections among the cells. Loss of gray matter in patients with schizophrenia has been linked to social withdrawal and progressive deterioration in cognition and emotion–which are among the least responsive symptoms to medications.

To see if antipsychotic drugs could slow the initial brain changes in new patients, Dr. Lieberman and colleagues at 14 sites in North America and Europe measured brain volume and cognitive changes in 263 first-episode schizophrenia patients and 58 non-schizophrenic volunteers over a two-year period. Half of the patients received the atypical antipsychotic olanzapine and the other half took the conventional antipsychotic haloperidol. Dr. Lieberman initiated the study when he was professor of psychiatry at the University of North Carolina, which also coordinated the research.

The study found that, on average, haloperidol-treated patients lost about two percent of their gray matter, or about 12 cubic centimeters. No changes were detected in the olanzapine-treated patients and the normal volunteers. Patients who lost gray matter, particularly in the frontal lobe of the brain, also had greater problems with cognitive functioning, as measured by tests of verbal fluency, verbal learning and memory.

Schizophrenia has always been known as a disease that causes progressive worsening of symptoms and deterioration in function, but only in the last 10 years have researchers found that the brains of schizophrenics are also progressively deteriorating.

“People used to think that the deterioration was inevitable, but now we’re thinking that if you can prevent the acute episodes of psychosis in schizophrenia you can actually stop the loss of gray matter,” Dr. Lieberman says.

“It also gives us hope that we will be able to completely forestall the disease in the future by intervening before psychosis even begins,” Dr. Lieberman adds. “In three to five years, we should have ways to identify which adolescents will become schizophrenic, and we can then begin to test the preventative power of treatments.”